AZ Water Scholarship - AZ Water Association

Information about Nominee
Name of Nominee*: Last: First: Middle Initial:
Title, Position:
Employer/Facility:
Years of Experience at
Facility:
Mailing Address:
Phone: ( ) Email:
Certification Status:
*Nominee must be a member of the AZ Water Association
Additional Information:
Why should the nominee be selected for this award? (Limit to 1000 characters)
Provide innovations and/or improvements made by the nominee. (Include efforts to
economize plant operations or maintenance, improve water quality, or make advancements in
treatment technology.) (Limit to 1000 characters)
Provide special contributions within the environmental field made by the nominee. (Limit to
1000 characters)
Awards Form - Operations Supervisor of the Year - Water Large.doc Revision date: 1/27/2013

Provide community service and/or public involvement by the nominee. (Limit to 1000
characters)
Provide contributions to AZ Water and/or other association activities by the nominee. (Limit to
1000 characters)
Information about Nominator
Name of Nominator:
Title, Position:
Agency, Employer:
Mailing Address:
Last: First: Middle Initial:
Phone: ( ) Email:
Additional Information
Please upload a photo of the nominee (.jpg, .tif, .bmp, or .pdf).
In addition, upload scanned copies or electronic files of the following: A completed ‘Plant and
System Certification Form’, one (1) recommendation letter from the nominee’s employer
(include name and position), and any additional biographical or other supporting material (.jpg,
.doc, or .pdf). Not to exceed 10 MB overall.
Awards Form - Operations Supervisor of the Year - Water Large.doc Revision date: 1/27/2013

Disclaimer
By submitting the information in this entry form, you are certifying the following:
All information in this application is true and honest
Permission for the AZ Water Association Awards Committee to share the application
materials for the purposes of selecting an award recipient
Please take the time to verify that all submitted information is correct.
A printable copy of the information submitted is available upon completion of the online form.
Awards Form - Operations Supervisor of the Year - Water Large.doc Revision date: 1/27/2013